Intra-articular Injection Of Sodium Hyaluronate Research Articles

Topical Chinese patent medicines for chronic musculoskeletal pain: systematic review and trial sequential analysis

PurposeChronic musculoskeletal pain (CMP) is defined as persistent or recurrent pain that occurs in the joints, musculo-soft tissue, spine or bones for more than three months and is not completely curable. Although topical Chinese patent medicine (CPM) is the most extensively utilized medication in Asia and is widely used for pain management, its efficacy remains controversial. This article presents a systematic review of clinical studies on the therapeutic properties of topical CPM for CMP patients to better inform clinical decision-making and provide additional and safer treatment options for patients with CMP.MethodWe performed a comprehensive search on PubMed, Cochrane Library, web of science and Chinese databases (CNKI and WanFang data) from 2010 to 2022. In all the studies, knee osteoarthritis, cervical spondylosis, low back pain, and periarthritis of shoulder met the International Pain Association definition of chronic musculoskeletal pain. We included only randomized controlled trials (RCTs) using topical CPM primarily for chronic musculoskeletal pain in adults. To determine the effect of topical CPM on clinical symptoms, we extracted the Visual Analog Scale (VAS, range 0–10) and the Western Ontario and McMaster Universities Arthritis Index pain scores (WOMAC pain, range 0–20), in which the lower the score, the better the results. We also accepted the comprehensive outcome criteria developed by the Chinese National Institute of Rheumatology as an endpoint (total effectiveness rate, range 0–100%, higher score = better outcome), which assesses the overall pain, physical function and wellness. Finally, trial sequential analysis of VAS pain score and total effectiveness rate was performed using TSA software.ResultsTwenty-six randomized controlled trials (n = 3180 participants) compared topical CPM with oral Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (n = 15), topical NSAIDs (n = 9), physiotherapy (n = 5), exercise therapy (n = 4), and intra-articular Sodium hyaluronate injection (n = 2). Sixteen studies found that topical CPM was statistically significant in improving CMP pain (measured by VAS pain and Womac pain scores)(p < 0.05), and 12 studies found topical CPMs to be more clinically effective (assessed by ≥ 30% reduction in symptom severity) in treating patients with CMP (p < 0.05). Trial sequential analysis indicates that the current available evidence is robust, and further studies cannot reverse this result. In most of the studies, randomisation, allocation concealment and blinding were not sufficiently described, and no placebo-controlled trials were identified.ConclusionMost studies showed superior analgesic effects of topical CPM over various control treatments, suggesting that topical CPM may be effective for CMP and is an additional, safe and reasonable treatment option. These reported benefits should be validated in higher-quality RCTs.

Retracted: Effect of Tongluozhitong Prescription-Assisted Intra-Articular Injection of Sodium Hyaluronate on VAS Score and Knee Lysholm Score in Patients with Knee Osteoarthritis.

[This retracts the article DOI: 10.1155/2021/3210494.].

Efficacy of acupotomy combined with sodium hyaluronate versus sodium hyaluronate alone in the treatment of knee osteoarthritis: A meta-analysis.

The efficacy of acupotomy combined with hyaluronic sodium acid in the treatment of knee osteoarthritis (KOA) is unclear. Therefore, this meta-analysis aims to evaluate the efficacy of acupotomy combined with hyaluronic sodium acid compared with hyaluronic sodium acid alone in the treatment of KOA. Studies from 8 Online databases were searched on KOA treatment using acupotomy combined with sodium hyaluronate until May 2022. The primary outcome indicator was clinical effectiveness, and the secondary outcome indicators included the visual analogue scale scores and Lysholm scores. We calculated the weighted mean difference (WMD) or relative risk for all relevant outcomes. Nine studies were identified, involving 644 cases. The results showed that acupotomy combined with intra-articular sodium hyaluronate injection for KOA was superior to sodium hyaluronate injection alone in terms of clinical effectiveness (relative risk = 1.17, 95% confidence interval [CI]: 1.09-1.25, P < .001) and visual analogue scale (WMD = -2.1, 95% CI: -2.25 to 1.95, P < .001), Lysholm score (WMD = 13.83, 95% CI: 3.47-24.19, P = .009). Acupotomy combined with intra-articular sodium hyaluronate injection for KOA is superior to sodium hyaluronate injection alone. Limited by the number and quality of included studies, this conclusion still needs to be verified by more high-quality Research. INPLASY202350029.

Acute Pseudoseptic Arthritis after Intra-Articular Sodium Hyaluronate Injection: A Case Report and Literature Review

Purpose: This report describes the case of 59-year-old woman with right medial compartment knee osteoarthritis (OA) who experienced an unusual adverse reaction to intra-articular sodium hyaluronate injection. Methods: The patient received an intra-articular sodium hyaluronate injection for treatment of knee OA. Ten days after injection, she experienced severe pain in her right knee wherein laboratory test results showed inflammatory profiles that could not rule out septic arthritis. Joint lavage was performed, after which the patient was monitored for any changes in her symptoms or laboratory test results. Results: The patient experienced severe pain in her right knee after intra-articular sodium hyaluronate injection. Additionally, laboratory test results showed inflammatory profiles that could not rule out septic arthritis. One month after joint lavage, the patient's symptoms resolved, and her laboratory test results returned to normal range. Conclusions: An inflammatory flare could occur as an adverse effect of intra-articular sodium hyaluronate injection, mimicking septic arthritis. Importantly, both physicians and patients should be aware of this potential reaction, particularly, patients should report any unusual symptoms to their healthcare provider.

Evaluation of the Anti-inflammatory Effect of Intra-articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in Mechanically Induced Temporomandibular Joint Injury in Rabbits

BACKGROUND: Degenerative arthritis is the most common form of arthritis, usually affecting the hands, feet, spine, knees, and temporomandibular joint (TMJ) as well. TMJ degenerative arthritis causes symptoms of painful joints, loss of joint function, limited mouth opening, joint instability, and clicking. Non-surgical symptomatic treatments can successfully be used to treat patients with degenerative arthritis. AIM: This study aimed to evaluate the anti-inflammatory effect of intra-articular injection of chondroitin sulfate and sodium hyaluronate in mechanically induced acute injury in TMJ of rabbits. METHODS: An animal study was conducted, all rabbits received a mechanical injury using a contra-angle handpiece with a speed of 120 rpm of a fissure bur 4 mm in diameter and 4 mm in depth extending to subchondral bone. Thirty-two rabbits were randomized into four groups: Control group, sodium hyaluronate “SH” group, chondroitin sulfate “CS” group, and “CS-SH” group. After 7 days, rabbits in the control group, “SH” group, “CS” group, and “CS-SH” group were respectively treated with normal saline, sodium hyaluronate, chondroitin sulfate, or combination of CS&amp;SH injection in the TMJ. All animals were treated once weekly for 3 weeks. A histological evaluation was performed. RESULTS: Histological findings showed a significantly reduced inflammatory cell, bone resorption, and fibrosis in the CS-HA-treated group. CONCLUSION: CS-SH injection has an anti-inflammatory effect on TMJ degenerative arthritis and aids in the reparative process.

Clinical Evaluation of Intra-Articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in the Management of Degenerative Osteoarthritis of Temporomandibular Joint

AIM: This study aims to evaluate the effectiveness of intra-articular injection of chondroitin sulfate and sodium hyaluronate in cases of temporomandibular joint (TMJ) degenerative osteoarthritis. MATERIAL AND METHODS: Thirty patients ASA I of both sexes, who were selected from outpatient clinic of Oral Surgery Department, Faculty of Dentistry – Suez Canal University, complaining of painful TMJ, presence of unilateral or bilateral TMJ pain, impairment of jaw movements, and joint sounds. Clinical examination was performed to all patients and pre-operative measurements of visual analog scale (VAS) for morning pain, pain with movement and spontaneous pain, maximum mouth opening, and presence or absence of clicking. Patients were randomly divided into two groups; (a) Study group consisted of 15 patients, they had intra-articular injection of chondroitin sulfate and sodium hyaluronate once weekly for 3 weeks and (b) control group consisted of 15 patients, they had intra-articular injection of sodium hyaluronate once weekly for 3 weeks. Post-operative measurements of VAS for previous pain types, maximum mouth opening, and clicking were obtained at 1 month, 3 months, and 6 months post-injection. RESULTS: There was a statistically significant reduction of all types of pain in the study group compared to the control group at all time intervals (p ≤ 0.05), for maximum mouth opening, there was a significant improvement in mouth opening in the study group for all time intervals (p ≤ 0.05), but for the clicking, there was not statistically significant difference between the study and control groups after 1 month, 3 months, and 6 months. The difference between groups was barely statistically significant (p = 0.05). CONCLUSION: Intra-articular injection of a combination of chondroitin sulfate and sodium hyaluronate is an effective tool in reducing pain, clicking, limited mouth opening, and other symptoms associated with degenerative TMJ diseases.

Medium-Term Effect of Treatment with Intra-Articular Injection of Sodium Hyaluronate, Betamethasone and Platelet-Rich Plasma in Patients with Temporomandibular Arthralgia: A Retrospective Cohort Study.

Temporomandibular joint disorders are associated with pain and reduced jaw mobility. The aim of this study was to compare the long-term effect on pain of intra-articular TMJ injections of betamethasone, sodium hyaluronate and platelet-rich plasma. The sample was made up of 114 patients, who were randomly distributed into three groups at least three years ago and who achieved a total remission of pain after treatment. We found that the median number of months without pain was, according to each group, as follows: platelet-rich plasma: 33; sodium hyaluronate: 28; betamethasone: 19. Both platelet-rich plasma and sodium hyaluronate lead to significant pain-free time after treatment; when we compare bethametasone with the two other substances, it proved to be very ineffective.

Acupotomy combined with intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis.

This retrospective study aimed to compare the effects of acupotomy combined with intra-articular injection of sodium hyaluronate (IA-SH) for the treatment of knee osteoarthritis (KOA). Eighty electronic medical records of patients with KOA were retrospectively analyzed. The patients were divided into an intervention group (n = 40, acupotomy plus IA-SH) and a control group (n = 40, IA-SH). Outcome measures included the visual analog scale, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and adverse events. Outcome data were collected and analyzed before and after treatment. The results of this study showed that there was a greater reduction in the visual analog scale (P < .01) and WOMAC scores (pain, P < .01; stiffness, P < .01; function, P < .01; total, P < .01) in the intervention group than in the control group. In addition, there were no significant differences in adverse events between the 2 groups. In this study, the effects of acupotomy plus IA-SH were superior to those of IA-SH alone for the treatment of patients with KOA. Further prospective studies are required to confirm these findings.

Study on the Long-term Efficacy and Joint Function Recovery of Intra-articular Injection of Sodium Hyaluronate in the Treatment of Osteoarthritis

Study on the Long-term Efficacy and Joint Function Recovery of Intra-articular Injection of Sodium Hyaluronate in the Treatment of Osteoarthritis

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis

Outcome of intra-articular corticosteroid vs. intra-articular ketorolac in symptomatic knee osteo-arthritis: a retrospective study

Background: Main target of treatment of osteoarthritis is improvement of pain relief and functional impairment. Intra-articular triamcinolone injections are most common treatment approach in India in the non-operative management of painful osteoarthritis knee. Corticosteroids can significantly reduce local inflammatory reactions but have side effects like cartilage toxicity and increase risk of local infection. Nonsteroidal anti-inflammatory drugs have been considered as an alternative in intra-articular injections for analgesia. They have strong anti-inflammatory effects and fewer adverse reactions as compared with triamcinolone injections. The primary aim of this study was to compare the outcome of patients with symptomatic knee osteo-arthritis receiving either an intra-articular ketorolac or corticosteroid injection.Methods: Our study is case-control, retrospective comparative study, a total of 50 patients with symptomatic knee osteo-arthritis, All patients received 4, weekly injection. triamcinolone or ketorolac for first three weeks and on 4th week only intra-articular sodium hyaluronate injections. All the parameters (VAS, WOMAC) were evaluated and recorded at 1st, 2nd, 5th weeks and 3 months after first injection.Results: At the first week, the VAS score was lower in group A, but no significant differences were found at any other time point as per WOMAC score and VAS score. And there was insignificant difference in group 1 and 2 scores.Conclusions: Both intra-articular injections regimen showed nearly same efficacy with clinically insignificant difference, ketorolac intra-articular injection can alleviate steroid’s side effects.

Attenuation of osteoarthritis progression through intra-articular injection of a combination of synovial membrane-derived MSCs (SMMSCs), platelet-rich plasma (PRP) and conditioned medium (secretome)

PurposeOsteoarthritis (OA) as a progressive destructive disease of articular cartilage is the most common joint disease characterized by reduction of joint cartilage thickness, demolition of cartilage surface and new bone formation. To overcome these problems, the purpose of the current research was to evaluate and compare the in vivo effects of synovial membrane-derived mesenchymal stem cell (SMMSCs), platelet-rich plasma (PRP) and conditioned medium (secretome) on collagenase II-induced rat knee osteoarthritis (KOA) remedy.MethodsFor the first step, SMMSCs were isolated and characterized. Also, secretome was collected from SMMSCs culture. Furthermore, PRP was collect from the rat heart venous blood. Second, two injection of collagenase II with an interval of 3 days was performed in the knee intra-articular space to induce osteoarthritis. Two weeks later, animals were randomly divided into 6 groups. Control group without treatment, positive group: taken an intra-articular sodium hyaluronate injection (0.1 ml), treatment groups taken an intra-articular injection of; treatment 1: SMMSCs (5 × 106), treatment 2: SMMSCs (5 × 106)/secretome (50 µl), treatment 3: SMMSCs (5 × 106)/PRP (50 µl), and treatment 4: SMMSCs (5 × 106)/ secretome (50 µl)/ PRP (50 µl). Three months later, rats were killed and the following assessments were executed: radiography, histopathology, and immunohistochemistry.ResultsOur findings represented that a combination of the SMMSCs/secretome/PRP had a considerable effect on glycosaminoglycans (GAGs) and collagen II contents, articular cartilage preservation, compared with other groups. In addition, combination of the SMMSCs with PRP and secretome showed the lowest expression of mmp3, while SOX9 had the highest expression in comparison with other groups. Also, SMMSCs-injected groups demonstrated better results compared with positive and control groups.ConclusionsInjecting a combination of the SMMSCs/secretome/PRP resulted in better efficacy in terms of joint space width, articular cartilage surface continuity and integrity, sub-chondral bone and ECM constituents such as collagen II. Indeed, transplantation of this combination could be considered as a preliminary therapy for clinical trial study in the future.

Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint

Aim:The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).Settings and Design:Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done.Subjects and Methods:Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated.Statistical Analysis Used:The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's post hoc test were used.Results:The mean age is 33 years, with female predominance. The statistical significant differences (P < 0.05) in pain and MIO between the 3 groups at the end of 3rdweek, 4thweek, and 3rd month postoperatively are seen in PRP group comparative to other groups.Conclusions:Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.

Effect of Tongluozhitong Prescription-Assisted Intra-Articular Injection of Sodium Hyaluronate on VAS Score and Knee Lysholm Score in Patients with Knee Osteoarthritis.

Knee osteoarthritis (KOA) has become one of the leading causes of workforce loss in the middle-aged and elderly population and a global public health problem second only to cardiovascular disease, so we need to find more effective treatments for this disease. In this study, we selected 120 patients with KOA admitted to our hospital from June 2018 to December 2020 and divided them into treatment group 1, treatment group 2, and joint group according to the random number table method, with 40 patients in each group. Treatment group 1 was treated with Tongluozhitong prescription dip-soaking therapy, treatment 2 group was treated with intra-articular injection of sodium hyaluronate, and the joint group was treated with a combination of both modalities for 4 weeks in all three groups. Clinical efficacy, visual analogue scale (VAS), Lysholm knee score (LKS), activity of daily living score (ADL), the levels of bone metabolic markers such as cartilage oligomeric matrix protein (COMP), type II collagen degradation maker (CTX-II), and matrix metalloproteinase-3 (MMP-3), and the levels of inflammatory mediators such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) were used as observations to compare and analyze the therapeutic effects of the three treatment regimens in KOA patients. The results showed that the clinical excellence rates of the joint group, treatment group 1, and treatment group 2 were 72.50%, 50.00%, and 90.00%, respectively, with statistically significant differences between any two comparisons. After treatment, VAS scores, serum COMP, CTX-II, MMP-3, IL-1β, TNF-α, and hs-CRP levels decreased in all three groups, and the levels of each index were as follows: joint group < treatment group 1 < treatment group 2, and the difference between any two comparisons was statistically significant. The LKS score and ADL score increased in all three groups, and the levels of each index were as follows: joint group > treatment group 1 > treatment group 2, with statistically significant differences in any two groups compared. None of the patients in the three groups experienced any significant adverse effects during treatment. This suggests that the dip-soaking therapy of Tongluozhitong prescription is more advantageous than intra-articular sodium hyaluronate injection treatment in suppressing the level of serum bone metabolic markers and inflammatory mediators, reducing pathological joint damage, relieving symptoms of pain, alleviating degenerative joint symptoms, and improving knee function in KOA patients. The combination of the two in KOA patients can significantly improve the efficacy and has a good safety profile.

Intra-Articular Injection of PRP in the Treatment of Knee Osteoarthritis Using Big Data.

Observing data on the characteristics of intra-articular injection of sodium citrate for knee osteoarthritis is an important reference value for human safety and evacuation design. To address the problems of slow data collection and poor accuracy of results of knee osteoarthritis behavior, under intensive conditions of intra-articular injection for knee osteoarthritis, this paper designs a data mining-based feature extraction system for intra-articular injection of sodium citrate for knee osteoarthritis. Using the Hadoop architecture, we extract the basic data of human behavior in the two-dimensional plane by storing and stitching the collected continuous data and discriminate the behavioral categories of knee osteoarthritis. We collected a real dataset from 84 patients with knee osteoarthritis treated in our hospital from October 2019 to October 2020. The dataset was divided into 42 patients in the tretinoin group and 42 patients in the sodium glutamate group according to the randomized number table method. The trimethoprim group was treated with intra-articular injection of trimethoprim, and the sodium citrate group was treated with intra-articular injection of sodium citrate. The clinical efficacy, joint mobility, intra-articular fluid volume, Lysholm score of knee joint, numerical pain intensity scale (NRS) score, and adverse effects of the two groups were compared before and after treatment. In our experiments, we observed that, compared with triamcinolone acetonide intra-articular injection, sodium hyaluronate intra-articular injection is more effective in the treatment of knee osteoarthritis. It can effectively improve knee function and reduce pain and adverse reactions.

Effects and Safety of Intra-Articular Sodium Hyaluronate Injection for the Treatment of Ankle Osteoarthritis: A Prospective Clinical Trial

Various nonoperative treatments have been implemented to reduce pain and improve the quality of life in patients with ankle osteoarthritis. Among these treatments, intra-articular hyaluronate injection has proven efficacy and safety in patients with knee osteoarthritis. The purpose of this study was to evaluate the efficacy and complications of hyaluronate injection using various clinical scoring systems. This study included 37 patients with unilateral ankle osteoarthritis (grade 2 or 3 according to the Takakura classification) who did not respond to previous pharmacological treatment. 3 weekly hyaluronate injections (2 mL Hyruan Plus®) were administered. The efficacy of intra-articular hyaluronate injection was evaluated on the basis of patient-reported foot and ankle clinical assessment at a mean follow-up of 13.8 ± 8.3 (range 6-33) months. Ankle Osteoarthritis Scale scores for pain and disability, American Orthopedic Foot and Ankle Society ankle-hindfoot scores, and visual analog scale for pain significantly improved at the final follow-up compared to that before intra-articular hyaluronate injection (p ≤ .05). When patients were dichotomized according to age, sex, body mass index, symptom duration, and Takakura classification, all these factors were not related to clinical outcomes. This study suggests that 3 weekly intra-articular hyaluronate injections can be performed safely to reduce pain and improve function without serious complications in patients with early or intermediate-grade ankle osteoarthritis when patients inadequately respond to medication. Larger controlled studies are needed to clarify the effects of hyaluronate injection and identify patients who can benefit most from hyaluronate injection.

Comparative analysis of intra-articular injection of steroid and/or sodium hyaluronate in adhesive capsulitis: prospective, double-blind, randomized, placebo-controlled study.

BackgroundFew studies have reported the effects of simultaneous injections of corticosteroid (CS) and hyaluronic acid (HA) on adhesive capsulitis (AC) of the shoulder. This study investigated the synergistic effects of simultaneous intra-articular injections of CS and compared them to those of CS or HA alone.MethodSixty patients with AC were enrolled in this randomized, placebo-controlled trial. The participants were divided into 4 groups: saline, CS, HA, and CS with HA groups. The primary outcome measure was changes in the Shoulder Pain and Disability Index (SPADI) scores at one month. The secondary outcome measures included changes in pain, range of motion, muscle strength, and additional shoulder functional scores at 1 day, 1 week, and 1, 3, and 6 months after injection.ResultsAfter 1 month, changes of the SPADI scores were significantly higher in the CS with HA group (−58.4%) than those in the saline (−7.7%) and HA (−14.4%) groups. The score changed more in the CS with HA group than that in the CS group (−43.7%), but there was no significant difference. In the changes in pain, the CS with HA group showed significantly better and faster effects than the saline and HA groups. In the changes of range of motion, functional scores, the CS with HA group showed better results than the saline and HA groups.ConclusionIn the treatment of AC, the simultaneous injection of CS and HA was more effective in improving SPADI scores at one month after injection than a single injection of CS or HA.

A meta-analysis and systematic review of the therapeutic effects of arthroscopy combined with intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis.

Knee osteoarthritis (KOA) causes joint pain and dysfunction that severely affects the patient's ability to walk. Arthroscopy combined with intraarticular injection of sodium hyaluronate can slow the development of knee osteoarthritis, but there is a lack of rigorous evidence-based medicine evaluation, and it has not been recognized by some scholars at home and abroad. This paper analyzed the clinical efficacy of arthroscopy combined with intraarticular injection of sodium hyaluronate in slowing knee osteoarthritis based on Lysholm score. Randomized control trials of arthroscopy combined with intra-articular injection of sodium hyaluronate in the treatment of KOA on Chinese and English databases were retrieved using the following search terms: "knee osteoarthritis", "arthroscopic debridement of the joint", "articular cavity", and "sodium hyaluronate". The quality of the literature was evaluated using the Rev Man 5.3 software. Twelve literatures were included in the meta-analysis. Regarding Newcastle-Ottawa Scale (NOS) score, of the 12 literatures, 7 literatures (58.33%) scored 6-9 points, 3 literatures (25%) scored 3-5 points, and 2 literatures (16.67%) scored 0-2 points. With a random effects model used for analysis, the Lysholm score after 1 month of combined treatment was significantly higher than that before treatment [mean difference (MD) =30.65, 95% confidence interval (CI): 19.44, 41.86, P<0.01]. Further, after 3 months of combination treatment, the Lysholm score was significantly higher than that before treatment (MD =24.04, 95% CI: 13.75, 34.32, P<0.01), and the same trend was also observed after 6 months (MD =20.41, 95% CI: 14.43, 26.40, P<0.01) and after 12 months (MD =20.86, 95% CI: 8.99, 32.72, P<0.01) of combination treatment. Overall, the combined treatment achieved significantly better clinical therapeutic effects than the single treatments in the control group [odds ratio (OR) =7.51, 95% CI: 4.84, 11.65, P<0.01]. This meta-analysis has confirmed that arthroscopy combined with intra-articular injection of sodium hyaluronate demonstrates significant clinical therapeutic effects in the treatment of KOA. This combination treatment can significantly improve knee joint function, relieve clinical symptoms, and improve patients' quality of life.

Evaluation of Intra-articular Injection of Simvastatin versus Hyaluronic Acid in Treatment of Internal Derangement of Temporomandibular Joint

ABSTRACTIntroduction: TMJ Internal Derangement is a common form of temporomandibularjoint disorder. Almost 80% of adult symptomatic patients with TMD have some form ofID. Temporomandibular joint arthrocentesis consists of lavage of upper joint space ofTMJ done with no direct vision, aiming primarily to remove necrotic tissue, bloodand pain mediators from the joint. One of these therapeutic substances is hyaluronicacid; which is a polysaccharide of the family of glycosaminoglycans, which can befound in many extracellular tissues, including synovial fluid and cartilage. Simvastatinsare group of drugs which have good results in regeneration of degenerated TMJ.Aim: This study aimed to evaluate the intra-articular injection of simvastatin versussodium hyaluronate following arthrocentesis for management of internal derangement(ID) of the temporomandibular joint(TMJ). Patients and methods: Thirty patients withinternal TMJ derangement were included in this study. All patients were subjected topreoperative clinical examination and preoperative magnetic resonance imaging (MRI)for the affected joints. Arthrocentesis was performed firstly for the affected joints inall patients followed by intra-articular injection of 1ml. simvastatin twice a month (ingroup I) and sodium hyaluronate twice a month ( in group II).Clinical follow up weredone at 24 hours post-operatively, one week, one month,and six months. Then, after sixmonths MRI was repeated to compare with preoperative images. Results: Better resultswere recorded with simvastatin group in comparison to sodium hyaluronate group; at 1week, 1 month,and six months intervals; which was superior to arthrocentesis followedby sodium hyaluronate intra-articular injection. Patients in group I showed better MRIfindings in comparison to group II where the position of the disc was almost returnedto its normal anatomical position. Conclusion: Arthrocentesis followed by simvastatinintra-articular injection was superior to the combination of arthrocentesis and sodiumhyaluronate intra-articular injection for management of TMJ internal derangementssymptoms.

Pilot Study to Evaluate the Efficacy of Polynucleotide Sodium Compared to Sodium Hyaluronate and Crosslinked Sodium Hyaluronate in Patients with Knee Osteoarthritis.

Degenerative arthritis of the knee joint has become a major social problem worldwide due to population aging. There are several treatment options for knee osteoarthritis, and the intraarticular injection of sodium hyaluronate is commonly selected by many clinicians as a nonsurgical treatment. However, the efficacy of the treatment is controversial. In this pilot study, we aimed to compare polynucleotide sodium (Conjuran®) with sodium hyaluronate (Hyruan Plus®) and 1,4-butanediol diglycidyl ether-crosslinked sodium hyaluronate (Synovian®) in terms of analgesic efficacy after intraarticular injection in patients with knee osteoarthritis. One of the three intraarticular agents was selected according to what agents were available for outpatients when each patient was enrolled in the study. The 15 enrolled patients were subdivided into 3 groups of 5 patients each. Three injections were performed under ultrasound guidance at a 1-week intervals over a total of 3 weeks. The visual analog scale (VAS) score, the Korean version of the Western Ontario and McMaster Universities Arthritis Index (K-WOMAC), the EuroQol five-dimension scale (EQ-5D) score, and the Korean version of the painDETECT Questionnaire (K-PDQ) score were evaluated before injection and at 1, 2, and 6 weeks after the start of the treatment protocol. The primary endpoint was the change in weight-bearing pain at 4 weeks after the last injection. Secondary endpoints included pain at rest and during walking and the K-WOMAC, EQ-5D, and K-PDQ scores. Weight-bearing pain decreased significantly more from pretreatment to 6 weeks after the start of the treatment protocol in the polynucleotide sodium-treated patients than in the patients who were treated with other agents (p = 0.006, one-way ANOVA). There were no significant between-group differences in the other secondary endpoints. No adverse events occurred. In conclusion, polynucleotide sodium could effectively reduce weight-bearing pain in the patients with knee osteoarthritis compared to standard hyaluronic acid viscosupplementation.